Feasibility of Assessing Pediatric Dental Benefit Enrollment in California

Objectives: The Affordable Care Act (ACA) mandates pediatric dental coverage as an essential health benefit. This study determines the availability and accessibility of data required to evaluate the impact of the ACA on pediatric oral heath through dental plan enrollment, utilization, dental care access, and health outcomes in California.
Methods: To determine data requirements for policy assessment, we completed a literature review and expert interviews. We compiled a list of commonly used dental measures and identified potential data sources using plan contracts, reporting regulations, and publicly available data. To assess data availability and measures, we examined California and federal exchange enrollment reports and spoke with representatives from Covered California (CC), dental plans, and dental organizations. We then mapped the flow of information through the dental system. We interviewed children’s health advocates and dental plan experts to identify barriers preventing data accessibility.
Results: Statewide total enrollment data is available through CC as of August 2014. Standardized enrollment and utilization reporting requirements are expected in 2015, but additional measures required to assess care access and health outcomes are unlikely, as is full release of collected data. Barriers limiting data accessibility for research include: market competition between plans discouraging voluntary data release, lack of regulatory reporting requirements and standardized dental measures, and the infrastructure and staffing needed for timely data processing.
Conclusions: While CC leads the nation in releasing enrollment information and requiring quality analysis of dental plans, data currently available only allows for limited analysis. Lack of data inhibits researchers’ ability to objectively monitor ACA implementation and make policy recommendations. This study confirms the need for system-wide collection and release of cohesive, standardized dental plan data to facilitate the timely and comprehensive analysis required to provide feedback integral to improving pediatric dental policy.